This application addresses broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic (05-DE-102) treatment of tobacco and drug dependence in dental settings. Electronic dental records (EDR) are a potentially powerful tool to incorporate current scientific evidence into clinical practice by providing key information at the point of patient care. We know that disseminating evidence- based guidelines is not sufficient to change clinical practice so innovative approaches need to be tested in dentistry. The composite expertise of the investigators and consultants on this project and a large group practice with multiple clinics utilizing one EDR are essential to address the aims of this study. This project will examine whether dentists and hygienists will assess interest in quitting and deliver a tobacco intervention more frequently when provided with computer assisted guidance compared to a control group. Specifically we will measure the delivery of questions assessing willingness to change and appropriate interventions based on willingness to change by measuring the recording of these activities in the EDR and patient receipt of these recommendations through a phone survey. In addition, the study will do a qualitative assessment of the patient perceived value of the provider-patient encounter to further inform us about patient perception of this interaction. We want to know if dental providers will utilize these tools during the dental encounter. If they are used, we would propose further studies examining smoking cessation rates. We were not able to measure cessation rates due to the short two year timeline of this funding mechanism. This tool has potential application for other clinical topics, which makes this approach very innovative when considering the translation of evidence into the unique clinical practice of dentistry. This study will modify an existing electronic dental record to create recommendations for dentists and dental hygienists to provide for their patients that smoke. Smoking has major impact on health in general but it also causes gum disease and oral cancer. We will examine if dental providers with these tools provide more tobacco interventions compared to providers who do not have these tools.